Provider Demographics
NPI:1922588128
Name:MUELLER, SUSAN DIANE (RN CDE)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:RN CDE
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:DIANE
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:404 N CAYUGA STREET
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-277-0969
Mailing Address - Fax:607-277-3242
Practice Address - Street 1:404 N CAYUGA STREET
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-277-0969
Practice Address - Fax:607-277-3242
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY671617163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator